JOCGP 10.5005/jp-journals-10028-1222
Gabriel Lazcano-Gomez et al
ORIGINAL REASEARCH
Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico 1 7
Gabriel Lazcano-Gomez, 2Jeffrey R Soohoo, 3Anne Lynch, 4Levi N Bonell, 5Karina Martinez, 6Mauricio Turati Roberto Gonzalez-Salinas, 8Jesus Jimenez-Roman, 9Malik Y Kahook
ABSTRACT Aim: To describe the demographic characteristics, ocular comorbidities, and clinical outcomes of patients with neovascular glaucoma (NVG) and to determine the number of patients who returned for a follow-up eye examination. Materials and methods: We examined the clinical data of patients with NVG, who attended a glaucoma clinic between July 2010 and November 2014. We collected information on the demographic characteristics of the patients to include the level of education, ocular comorbidities, NVG stage, visual acuity, glaucoma medications, intraocular pressure (IOP), and the number of patients who had a follow-up ocular examination at month 1, 3, 6, and 12. Results: Data from 350 patients (473 eyes) with NVG were collected. We found 91% of the cohort had proliferative diabetic retinopathy (PDR). We found blindness in both or one eye in 14% and 31% of the cohort respectively. Low vision was found in both or one eye in 14% and 32% of the eyes respectively. By 6 months follow-up, only 32% of the patients were seen at our clinic and by 12 months follow-up, this number decreased to 15%. Around 60% of the patients were on no IOP lowering drugs at the first visit. We found 53% of the cohort had an incomplete elementary school education. Conclusion: The results suggest that advanced NVG is a significant ocular problem for patients referred to our clinic with just over half of the patients presenting as blind. We also found that several socioeconomic factors that had an important role in the development of PDR and NVG, specifically, educational status. Clinical significance: We described the characteristics of a large cohort of patients with very advanced NVG, reflecting the fact that the strict control of the underlying disease must be the main goal of the Mexican national health system. Keywords: Education, Mexico, Neovascular glaucoma, Outcomes, Socioeconomic. How to cite this article: Lazcano-Gomez G, Soohoo JR, Lynch A, Bonell LN, Martinez K, Turati M, Gonzalez-Salinas R,
1
Research Scholar, 2Assistant Professor, 3Associate Professor Professional Research Assistant, 5Fellow 6,9Professor 8 Chief 4,7
1-4,9
Department of Ophthalmology, School of Medicine, University of Colorado, Colorado, USA 5-8 Department of Glaucoma, Asociacion para Evitar la Ceguera en Mexico APEC, Mexico city, Mexico
Corresponding Author: Gabriel Lazcano-Gomez, Research Scholar, Department of Ophthalmology, School of Medicine University of Colorado, Colorado, USA, Phone: +009093192163 e-mail:
[email protected]
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Jimenez-Roman J, Kahook MY. Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico. J Curr Glaucoma Pract 2017;11(2):48-51. Source of support: Nil Conflict of Interest: None
INTRODUCTION Neovascular glaucoma (NVG) is defined as severe glaucoma associated with the presence of new iris vascularization (NVI) or angle (NVA) vessels.1 Patients with NVG typically present with a very high intraocular pressure (IOP) and hyphema.2 Once NVG develops and IOP becomes elevated, treatment becomes challenging and the outcome is often irreversible visual loss.3-7 Investigators from the United States of America and China have studied patients with advanced NVG and described central retinal vein obstruction (CRVO), proliferative diabetic retinopathy (PDR) and ocular ischemic syndrome as major comorbidities that place a patient at risk for adverse NVG-related ocular complications.8-9 However, apart from these studies, few investigators have reported the clinical characteristics of patients with NVG and their outcomes. Moreover, there has been no comprehensive review of patients with NVG from Latin America where a large proportion of the patients with diabetes have diabetic retinopathy (DR).10 The purpose of this study is to: (1) Describe the demographic characteristics, ocular comorbidities and clinical outcomes of patients with NVG and (2) determine the number of patients who returned for a follow-up eye examination. To address these aims, we conducted a retrospective cohort study of patients with advanced NVG who received care at a tertiary eye care center in Mexico City.
MATERIALS AND METHODS This retrospective chart review was approved by the ethics committee of the Asociación para Evitar la Ceguera en México (APEC), a referral center for complex eye diseases located in Mexico City. We examined the clinical data of all patients who attended the glaucoma clinic at APEC between July 2010 and November 2014. We collected information on the demographic characteristics of
JOCGP Neovascular Glaucoma: A Retrospective Review from a Tertiary Eye Care Center in Mexico
the patients to include: Age, gender, and level of education (categorized as incomplete elementary school education, elementary school, high school, and college/degree). We documented if the patient had CRVO, PDR, ocular ischemic syndrome, uveitis or other ocular comorbidities. The NVG stage was recorded and defined as: Stage I: NVI/NVA with normal IOP, Stage II: NVI/NVA, open angle and IOP above normal limits, and Stage III: Angle-closed glaucoma with high IOP (described in detail elsewhere).11 Visual acuity was categorized as normal vision (20/60--20/15; Snellen), low vision (20/400 – 20/80), and blind (
